Sexual dysfunction in males suffering from spinal cord injury, SCI and other neurological conditions such as multiple sclerosis is well known. Impotence is the most common problem, but inability to ejaculate may also occur. Whereas those suffering from impotency may obtain penile prosthesis implantation or intracavernous injection therapy, those with anejaculation, nonetheless, are infertile. Until the present invention, no therapy has been available for this condition. To reduce spasticity in both males and females afflicted with SCI is likewise an objective of invention. Similar problems arise in females suffering from SCI.
Normal ejaculatory function in the human male implies a coordinated sequence of smooth and striate muscular contractions to promote projectile, antegrade transport of seminal fluid. This process begins with transmission of afferent nerve stimuli via the internal pudendal nerve from the penile shaft to higher centers. To complete the ejaculatory reflex efferent stimuli are transmitted from the anterolateral columns of the spinal cord and emerging from the thoracolumbar level to comprise a hypogastric or sympathetic plexus. From the interior mesenteric ganglion short adrenergic postganglionic fibers terminate in the seminal vesicles, vasal ampullae, and bladder neck. Sympathetic innervation of the seminal vesicles results in seminal emission into the posterior urethra. Appropriately timed bladder neck closure prevents retrograde passage of this semen bolus, which is propelled in the antegrade direction by clonic contracts of the bulbocavernosus and ischiocavernosus muscles of the pelvic floor. Electrojaculation studies in spinal cord transected primates indicate that the presence of postganglionic short adrenergic fibers are the minimal requirement for electrostimulated ejaculation. The fact that emission can be successfully electrostimulated by rectal probe electrode, up to two years following cord abation, indicates that the normal ejaculatory reflex can be bypassed.
Retrograde ejaculation has been noted as a constant finding in electroejaculatory stimulation by rectal probe electrode. In contrast to its action in normal ejaculation, the electrostimulated bladder neck must either be unresponsive or must undergo delayed closure.
Electroejaculation by rectal probe electrode has, in a short period, impacted significantly on the fertility potential of spinal cord injured men. This specific group, previously considered "sterile", can now undergo semen procurement predictably and safely. Importantly, they may benefit from the same sperm assessment procedures and in-vitro sperm enhancement techniques as applied to the general population seeking infertility testing and treatment.
Whereas electroejaculation has been used for inducing emission of semen both in animals and in humans, the present technique employs an electrical probe which is placed in the rectum. The probe is connected to a combination electrical stimulator and temperature meter and upon order, current is delivered to the probe in a sine-wave pattern. During stimulation, carefully disposed bipolar electrodes are directed anteriorly to stimulate those short neurons entering the ejaculatory organs, which lie anterior to the rectum. As the electrical stimulus is being applied, the bulbous and pendulous urethra are "milked" to encourage an antegrade ejaculate. The bladder is irrigated with modified Hamm's F-10 solution to retrieve the maximum number of sperm. Hitherto, the most widely used successful application of electroejaculation has been in spinal-cord-injury patients. It has also been used to obtain semen after retroperitoneal lymph node dissection (RPLND), MS, diabetes neurol tube defect, and other neurogenic physiogenic conditions.
After experimentation with electroejaculation in various species of animals and following many years of experience working with animals, a study was initiated in 1985 using this technique to obtain semen in neurologically impaired men. The first subjects were men with spinal cord injury, hereinafter SCI; later electroejaculation was applied to men suffering from other neurological conditions; these include men who have had a retroperitoneal lymph node dissection, and those suffering from multiple sclerosis, adult diabetes and other non-specific anejaculatory disorders. The main research effort has been directed towards those with SCI. To date over 3,000 electroejaculation procedures have been applied to 250 men. The levels of injury for these SCI men have ranged from C3 to L2 with the majority being in the thoracic area and the injuries being complete. The overall success rate in obtaining an ejaculate, be it antigrade or retrograde, has been in the order of 80%. Working with those suffering from thoracic SCI lesions, there is approximately a 90% success rate in obtaining an ejaculate. If this latter group, some 75% will have an ejaculate considered sufficient quality for artificial insemination by inter-uterine deposition of washed spermatoza. Using the hereinafter described equipment and technique with SCI men, there have been 40 reported pregnancies in the U.S. Europe. Also a live birth in a couple where the husband has multiple sclerosis and a further two where the husbands had retroperitoneal lumph node dissections following surgical treatment for testicular cancer.
The method and apparatus are likewise effective in treating both males and females having SCI wherein spasticity may be effectively reduced for significant after treatment periods of time. See Example #2, hereinafter.